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I <br /> so <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C -TOMER TO PROVIDE <br /> OWNER NAME <br /> David Walford <br /> U Zoni g Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) De d Restriction; CSM <br /> 6770 Sunset Dr.Verona,WI 53593 V 'ance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)845-7721 (608)712-8715 dw6770 @tds.net <br /> e Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION d' dudes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> it Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE ❑Si Plan proval from <br /> a e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> I or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: levation of property <br /> ❑PARCEL 062/0608-352-9701-1 RH-1 4.3 frontage drawn to le. <br /> NUMBER <br /> TOWNSHIP: SE 0 ,\ <br /> • Verona 14_ N W 1/41/4.S E ❑Driveway p its <br /> ADDRESS: (state, nty,to.n) <br /> 6770 Sunset Dr. Verona, WI 53593 <br /> GSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary ■- mits <br /> 7,806 1 (public •rivate) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Treehouse MI Z-ring District <br /> . F This project is a new building or structure. ■ "ermitt -? <br /> This project is an addition/al ation to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ca Rural ddre A) <br /> EWER EPTIC (new -xistin. <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not in uding basement) <br /> 14.0 1.0 ❑ Wetland/Floo in/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shorela ttachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: / ❑ ErosionCOntr ermit <br /> ;O�J�II , TOTAL SQUARE FOOTAGE: j (slopes,di rbance, <br /> filling/a ss) <br /> 2ND FLOOR: 3RD FLOOR: �I I <br /> 'a 7 ❑ Review Location Survey/1 0 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 8,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ao 00on't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes no JDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYeso <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 1Yes DVo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank• none) <br /> 6. Is a location survey required? (see reverse) ❑Yes to ✓❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓�Vo <br /> 451 �� APPLICATION MUST BE SIGNED <br /> � p (Continue on Back) —0 ♦ —► <br /> 545-112(4/08) i ►,, <br />